<link rel="stylesheet" href="<?=style_url('formsecondaryinsert');?>">

<div>

	<table cellpadding="0" cellspacing="1">
		<tr>
			<td class="id_picture">
				logo
			</td>
			<td class="title">
				<p style="font-size:20; font-weight:bold;"><?=$school_name;?></p>
				<p style="font-size:12;"><?=$school_address;?></p>
				<p>&nbsp;</p>
				<p style="font-size:14; font-weight:bold;">SECONDARY LEVEL INSERT</p>
			</td>
			<td class="id_picture">
				2 x 2 picture
			</td>
		</tr>
	</table>

</div>

<div>

	<table cellpadding="0" cellspacing="1" style="padding:2 0 2 0;">
		<tr><td style="font-weight:bold;">PERSONAL INFORMATION</td></tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Name of Child:</td><td style="width:245;" class="underline">&nbsp;</td>
			<td>Nickname:</td><td style="width:150;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Date of Birth:</td><td style="width:120;" class="underline">&nbsp;</td>
			<td>Age:</td><td style="width:35;" class="underline">&nbsp;</td>
			<td>Year:</td><td style="width:35;" class="underline">&nbsp;</td>
			<td>Months:</td><td style="width:45;" class="underline">&nbsp;</td>
			<td style="width:220;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Place of Birth:</td><td style="width:183;" class="underline">&nbsp;</td>
			<td>Nationality:</td><td style="width:95;" class="underline">&nbsp;</td>
			<td style="width:220;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Level:</td><td style="width:150;" class="underline">&nbsp;</td>
			<td>Calendar:</td><td style="width:50;" class="underline">&nbsp;</td>
			<td>AIC</td><td style="width:50;" class="underline">&nbsp;</td>
			<td>Regular</td><td style="width:100;" class="underline">&nbsp;</td><td style="width:50;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>City Address:</td><td style="width:185;" class="underline">&nbsp;</td>
			<td>Tel. Nos.</td><td style="width:225;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Name of Father: </td><td style="width:170;" class="underline">&nbsp;</td>
			<td>Mother: </td><td style="width:235;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Occupation: </td><td style="width:197px;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td><td style="width:243;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Office Tel. No. </td><td style="width:176;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td><td style="width:235;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Religious Affilication: </td><td style="width:270;" class="underline">&nbsp;</td>
			<td style="width:260;">&nbsp;</td>
		</tr>
	</table>
	
	<table cellpadding="0" cellspacing="1" style="padding:4 0 4 0;">
		<tr>
			<td style="font-weight:bold;">FAMILY BACKGROUND</td>
		</tr>
	</table>
	
	<table cellpadding="0" cellspacing="1">
		<tr><td><span>STATUS OF PARENTS:</span> (Pls. Encircle) for how long</td></tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Married </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
		</tr>
		<tr>
			<td>Remarried </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
		</tr>
		<tr>
			<td>Living Together </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Single Parent </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Separated: </td><td>Location</td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
		</tr>
		<tr>
			<td>&nbsp;</td><td>Legal</td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
		</tr>
	</table>
	
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Do both parents have custodial rights over child:</td><td style="width:20;" class="all_around">&nbsp;</td><td>Yes</td><td style="width:20;" class="all_around">&nbsp;</td><td>No</td><td style="width:150;" class="underline">&nbsp;</td><td>only.</td><td style="width:100;">&nbsp;</td>
		</tr>
	</table>
	
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td width="40%">Methods of Discipline:</td>
			<td>Who does the discipline?</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:10;">&nbsp;</td>
			<td style="width:65;" class="underline">&nbsp;</td>
			<td style="width:230;">Spanking</td>
			<td style="width:65;" class="underline">&nbsp;</td>
			<td>Dad</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>Grounding</td>
			<td class="underline">&nbsp;</td>
			<td>Mom</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>Talking to the Child</td>
			<td class="underline">&nbsp;</td>
			<td>Guardian</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:10;">&nbsp;</td>
			<td style="width:200;" class="underline">&nbsp;</td>
			<td style="width:100;">Others</td>
			<td style="width:200;" class="underline">&nbsp;</td>
			<td>Others</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1" style="padding-top:4;">
		<tr>
			<td>Does your child have a regular study time?</td><td style="width:20;" class="all_around">&nbsp;</td><td>No</td><td style="width:20;" class="all_around">&nbsp;</td><td>Yes</td><td>&nbsp;&nbsp;Time:</td><td style="width:70;" class="underline">&nbsp;</td><td>With whom?</td><td style="width:90;" class="underline">&nbsp;</td><td style="width:45;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Your child's favorite pasttime:</td><td style="width:430;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>What does yout child hate to do:</td><td style="width:415;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Music your child likes to listen to:</td><td style="width:410;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>How does your child handle frustration?</td><td>&nbsp;</td>
		</tr>
		<tr>
			<td style="width:410;" class="underline">&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Does your child have a curfew?</td><td style="width:20;" class="all_around">&nbsp;</td><td>No</td><td style="width:20;" class="all_around">&nbsp;</td><td>Yes</td><td>&nbsp;What Time:</td><td style="width:80;" class="underline">&nbsp;</td><td style="width:240;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td width="40%">What do you consider as misbehavior? (pls. check)</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:10;">&nbsp;</td>
			<td style="width:65;" class="underline">&nbsp;</td>
			<td>Talking out loud</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>Answering back</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>Slamming the door</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:300;" class="underline">&nbsp;</td>
			<td>Others please specify</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Rule/s at home that you like the school to reinforce:</td><td style="width:310;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:310;" class="underline">&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Activities your family engages in:</td><td style="width:410;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:350;" class="underline">&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Information that the you would like the school to know that may hinder or help the child's learning process:</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:500;" class="underline">&nbsp;</td><td style="width:50;">&nbsp;</td>
		</tr>
	</table>
	
	
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>Do you allow your child to go home independently after class?</td><td style="width:20;" class="all_around">&nbsp;</td><td>No</td><td style="width:20;" class="all_around">&nbsp;</td><td>Yes</td><td style="width:200;">&nbsp;</td>
		</tr>
	</table>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td>If yes, please affix your signature on the space provided for:</td><td style="width:150px;" class="underline">&nbsp;</td><td style="width:170;">&nbsp;</td>
		</tr>
	</table>
	<p></p>
	<table cellpadding="0" cellspacing="1">
		<tr>
			<td style="width:20;">&nbsp;</td>
			<td style="width:200;" class="underline">&nbsp;</td>
			<td style="width:200;">&nbsp;</td>
			<td style="width:200;" class="underline">&nbsp;</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td style="text-align:center;">Date</td>
			<td>&nbsp;</td>
			<td style="text-align:center;">Parent's Name &amp; Signature</td>
		</tr>
	</table>

</div>